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25. Factors Associated With the Initiation of Comfort‐Focused Nutrition Care Orders for Long‐Term Care Residents at End of Life.

Author

Koechl, Jill, Banerjee, Albert, Heckman, George, and Keller, Heather

Subjects
DOCUMENTATION, CONVERSATION, T-test (Statistics), DEATH, RESEARCH funding, LONG-term health care, RESIDENTIAL patterns, STATISTICAL sampling, LOGISTIC regression analysis, PATIENT care, RETROSPECTIVE studies, DESCRIPTIVE statistics, CHI-squared test, ODDS ratio, NURSING care facilities, FOOD habits, QUALITY of life, MEDICAL records, ACQUISITION of data, CONFIDENCE intervals, TERMINAL care, DATA analysis software, TIME, NUTRITION, NUTRITION education, DEGLUTITION disorders
Abstract

Background: Comfort‐focused nutrition orders are recommended to manage eating changes among long‐term care (LTC) residents nearing the end of life, though little is known about their current use. This investigation aims to describe current practices and identify resident‐level and time‐dependent factors associated with comfort‐focused nutrition orders in this context. Methods: Data were retrospectively extracted from resident charts of decedents (≥65 years at death, admitted ≥6 months) in 18 LTC homes from two sampling frames across southern Ontario, Canada. Observations occurred at 6 months (baseline), 3 months, 1 month and 2 weeks prior to death. Extracted data included functional measures (e.g. cognitive performance, health instability) at baseline, formalised restorative and comfort‐focused nutrition care interventions at each timepoint and eating changes reported in the progress notes in 2 weeks following each timepoint. Logistic regression and time‐varying logistic regression models determined resident‐level (e.g. functional characteristics) and time‐dependent factors (e.g. eating changes) associated with receiving a comfort‐focused nutrition order. Results: Less than one‐third (30.5%; n = 50) of 164 participants (61.0% female; mean age = 88.3 ± 7.5 years) received a comfort‐focused nutrition order, whereas most (99%) received at least one restorative nutrition intervention to support oral food intake. Discontinuation of nutrition interventions was rare (8.5%). Comfort orders were more likely with health instability (OR [95% CI] = 4.35 [1.49, 13.76]), within 2 weeks of death (OR = 5.50 [1.70, 17.11]), when an end‐of‐life conversation had occurred since the previous timepoint (OR = 5.66 [2.83, 11.33]), with discontinued nutrition interventions (OR = 6.31 [1.75, 22.72]), with co‐occurrence of other care plan modifications (OR = 1.48 [1.10, 1.98]) and with a greater number of eating changes (OR = 1.19 [1.02, 1.38]), especially dysphagia (OR = 2.59 [1.09, 6.17]), at the preceding timepoint. Conclusions: Comfort‐focused nutrition orders were initiated for less than one‐third of decedents and most often in the end stages of life, possibly representing missed opportunities to support the quality of life for this vulnerable population. An increase in eating changes, including new dysphagia, may signal a need for proactive end‐of‐life conversations involving comfort nutrition care options. Implications for Practice: Early and open conversations with residents and family about potential eating changes and comfort‐focused nutrition care options should be encouraged and planned for among geriatric nursing teams working in LTC. These conversations may be beneficial even as early as resident admission to the home. [ABSTRACT FROM AUTHOR]

Published
2024
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31. CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction

Author

McDonald, Michael, Virani, Sean, Chan, Michael, Ducharme, Anique, Ezekowitz, Justin A., Giannetti, Nadia, Heckman, George A., Howlett, Jonathan G., Koshman, Sheri L., Lepage, Serge, Mielniczuk, Lisa, Moe, Gordon W., O’Meara, Eileen, Swiggum, Elizabeth, Toma, Mustafa, Zieroth, Shelley, Anderson, Kim, Bray, Sharon A., Clarke, Brian, Cohen-Solal, Alain, D’Astous, Michel, Davis, Margot, De, Sabe, Grant, Andrew D.M., Grzeslo, Adam, Heshka, Jodi, Keen, Sabina, Kouz, Simon, Lee, Douglas, Masoudi, Frederick A., McKelvie, Robert, Parent, Marie-Claude, Poon, Stephanie, Rajda, Miroslaw, Sharma, Abhinav, Siatecki, Kyla, Storm, Kate, Sussex, Bruce, Van Spall, Harriette, and Yip, Amelia Ming Ching

Published
2021
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33. Improving Clinical Care Outcomes for Canadian Seniors: Findings of a Pilot Study Evaluating an Applied Simulated and Integrated Learning Approach (ASILA) for Home Care Workers

Author

Boscart, Veronique M., Crutchlow, Lauren, Taucar, Linda Sheiban, Schelling, Sandra, Fung, Elliott, Betini, Raquel S. D., Heckman, George, and Hirdes, John

Abstract

Home care workers deliver care services to community-dwelling seniors across Canada, but home care workers' variable education and unfamiliarity with assessment data systems can impede client-centered care. This pilot study therefore examined the effectiveness and feasibility of five educational modules on geriatric care, developed with a pedagogical framework used to educate and empower home care workers, in improving care beliefs and attitudes, care provision challenges, and satisfaction with modules. Online versions of modules, which used clinical scenarios and interRAI home care to guide care procedures, were developed. Participants' care beliefs and attitudes, care provision challenges, and satisfaction were measured before and after module delivery using non-standardized questionnaires. Quantitative data was analyzed using descriptive and inferential statistics, whereas qualitative data was analyzed using content analyses. Although most participants already completed training at least once a year (52.9%) and believed they were knowledgeable of clients' needs (85.3%), modules showed significant improvement on 46.4% of participants' care attitudes and beliefs. Participants thought that modules focused on important educational topics for home care workers (94.3%) and provided useful information (n=19). The majority (79.5%) of participants were satisfied with modules and 68.6% could see them being completed online in the future. Educational modules, focusing on integrated and applied geriatric care interventions significantly improved home care workers' gerontological knowledge and skills. Accessible and low-cost continuing education on geriatric home care hereby presents as an effective and acceptable way of building home care workers' care capacity.

Published
2019
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34. The Medical Complexity of Newly Admitted Long-Term Care Residents Before and During the COVID-19 Pandemic in Ontario, British Columbia, and Alberta: A Serial Cross-Sectional Study.

Author

Al-Sharkawi, Razan, Turcotte, Luke A, Hirdes, John P, Heckman, George, and McArthur, Caitlin

Abstract

The COVID-19 pandemic had profound effects on the long-term care (LTC) setting worldwide, including changes in admission practices. We aimed to describe the characteristics and medical complexity of newly admitted LTC residents before (March 1, 2019 to February 29, 2020) and during (March 1, 2020 to March 31, 2021) the COVID-19 pandemic via a population-based serial cross-sectional study in Ontario, Alberta, and British Columbia, Canada. With data from the Minimum Data Set 2.0 we characterize the medical complexity of newly admitted LTC residents via the Geriatric 5Ms framework (mind, mobility, medication, multicomplexity, matters most) through descriptive statistics (counts, percentages), stratified by pandemic wave, month, and province. We included 45 756 residents admitted in the year prior to and 35 744 during the first year of the pandemic. We found an increased proportion of residents with depression, requiring extensive assistance with activities of daily living, hip fractures, antipsychotic use, expected to live <6 months, with pneumonia, low social engagement, and admitted from acute care. Our study confirms an increase in medical complexity of residents admitted to LTC during the pandemic and can be used to plan services and interventions and as a baseline for continued monitoring in changes in population characteristics over time. [ABSTRACT FROM AUTHOR]

Published
2024
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35. CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis

Author

O’Meara, Eileen, McDonald, Michael, Chan, Michael, Ducharme, Anique, Ezekowitz, Justin A., Giannetti, Nadia, Grzeslo, Adam, Heckman, George A., Howlett, Jonathan G., Koshman, Sheri L., Lepage, Serge, Mielniczuk, Lisa M., Moe, Gordon W., Swiggum, Elizabeth, Toma, Mustafa, Virani, Sean A., Zieroth, Shelley, De, Sabe, Matteau, Sylvain, Parent, Marie-Claude, Asgar, Anita W., Cohen, Gideon, Fine, Nowell, Davis, Margot, Verma, Subodh, Cherney, David, Abrams, Howard, Al-Hesayen, Abdul, Cohen-Solal, Alain, D’Astous, Michel, Delgado, Diego H., Desplantie, Olivier, Estrella-Holder, Estrellita, Green, Lee, Haddad, Haissam, Harkness, Karen, Hernandez, Adrian F., Kouz, Simon, LeBlanc, Marie-Hélène, Lee, Douglas, Masoudi, Frederick A., McKelvie, Robert S., Rajda, Miroslaw, Ross, Heather J., and Sussex, Bruce

Published
2020
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40. Focusing on Provider Quality Measurement: Continued Consensus and Feasibility Testing of Practice-Based Quality Measures for Primary Care Providers in Long-Term Care

Author

Dash, Darly, primary, Moser, Andrea, additional, Feldman, Sid, additional, Saliba, Debra, additional, Bakaev, Innokentiy, additional, Smalbrugge, Martin, additional, Robert, Benoît, additional, Karuza, Jurgis, additional, Heckman, George, additional, Katz, Paul R., additional, and Costa, Andrew P., additional

Published
2023
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41. Facteurs de risque d'eclosion de SRAS-CoV-2 dans les residences pour atnes en Ontario, au Canada: etude de cohorte a l'echelle de la population

Author

Costa, Andrew P., Manis, Derek R., Jones, Aaron, Stall, Nathan M., Brown, Kevin A., Boscart, Veronique, Castellino, Adriane, Heckman, George A., Hillmer, Michael P., Ma, Chloe, Pham, Paul, Rais, Saad, Sinha, Samir K., and Poss, Jeffrey W.

Subjects
Infection, Dwellings, Housing, Health
Abstract

CONTEXTE : L'epidemiologie de l'infection au SRAS-CoV-2 dans les residences pour aines (offrant une aide a la vie autonome), est pour une bonne part inconnue. Nous avons etudie le lien entre les caracteristiques des residences et des communautes avoisinantes et le risque d'eclosion de SRAS-CoV-2 dans les residences pour aTnes depuis le debut de la premiere vague de la pandemie de COVID-19. METHODES : Nous avons procede a une etude de cohorte retrospective dans la population des residences pour aTnes certifiees en Ontario, au Canada, entre le 1er mars et le 18 decembre 2020. Notre parametre principal etait toute eclosion de SRAS-CoV-2 ([greater than or equal to] 1 cas confirme parmi les residents ou le personnel au moyen d'un test d'amplification des acides nucleiques). Nous avons utilise la methode des risques proportionnels avec predicteurs chronologiques pour modeliser les liens entre les caracteristiques des residences et des communautes avoisinantes et les eclosions de SRAS-CoV-2. RESULTATS : Notre cohorte a inclus l'ensemble des 770 residences privees pour aTnes (RPA) certifiees en Ontario qui hebergeaient 56 491 residents. On a denombre 273 (35,5 %) residences pour aines qui ont connu 1 eclosion de SRAS-CoV-2 ou plus; 1944 residents (3,5 %o) et 1101 employes (3,0 %o) ont contracte l'infection. Ces cas etaient inegalement distribues entre les residences. En effet, 2487 cas parmi les residents et le personnel (81,7 %o) sont survenus dans 77 residences (10 [degrees]%). Le rapport de risque ajuste d'une eclosion de SRAS-CoV-2 dans une residence a ete clairement associe aux etablissements qui avaient une grande capacite d'accueil, qui comportaient des unites de soins de longue duree, qui appartenaient a de plus grandes bannieres et offraient plusieurs services sur place, qui se trouvaient dans des regions marquees par une hausse de l'incidence regionale de SRAS-CoV-2 et ou la concentration ethnique a l'echelle de la communaute etait superieure. INTERPRETATION : Certaines caracteristiques facilement identifiables des residences pour aTnes sont associees de maniere independante aux eclosions de SRAS-CoV-2 et peuvent faciliter devaluation des risques et orienter la priorisation de la vaccination., Les adultes ages fragiles qui vivent dans des milieux de vie collectifs ont ete au centre de la pandemie de COVID-19 au Canada et ailleurs dans le monde (1,2). Les [...]

Published
2021
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44. Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study

Author

Costa, Andrew P., Manis, Derek R., Jones, Aaron, Stall, Nathan M., Brown, Kevin A., Boscart, Veronique, Castellino, Adriane, Heckman, George A., Hillmer, Michael P., Ma, Chloe, Pham, Paul, Rais, Saad, Sinha, Samir K., and Poss, Jeffrey W.

Subjects
Ontario -- Health aspects, Epidemics -- Risk factors -- Statistics -- Canada, Assisted living facilities -- Health aspects -- Statistics, Health
Abstract

BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection ([greater than or equal to] 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home--and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination., Frail older adults living in congregate care settings have been at the centre of the COVID-19 pandemic in Canada and internationally. (1,2) Long-term care facilities--whose residents are the congregate living [...]

Published
2021
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